ARS - Adult Revenue Service affiliate program since 1997

1. WEBSITE INFORMATION

This site will be reviewed for acceptance into the ARS program. If no site exists, the application will be declined.

Website Name:
Website URL:

2. CONTACT INFORMATION

Important: You will be required to respond to an email to activate your account so you must use a valid email address

Email Address:

Contact Name:

Telephone Number:

Chat Client:

Chat Name/Number:

Checks Payable To:

Address:

City:

State / Province:

Zip Code:

Country:

Business Type:

Name on Tax ID / SSN:

Tax ID / SSN*:

*Only required if located in US
Note: The Tax ID/S.S.# field must be formated as follows:
The numbers must contain dashes.
Tax ID: (xx-xxxxxxx)
S.S.#: (xxx-xx-xxxx)

3. FUNDS DISTRIBUTION

Note: Affiliates may chose to have their checks sent overnight for a $15 fee. Wire transfer fees are $10 for US and $20 for international. A minimum payout of $500 (US) / $1000 (International) must be met for all wire transfers.

Minimum Payout:

Desired Payout:

	Standard Check
	Overnight Check (Fee: $15 US / $25 International)
	Wire Transfer (Fee: $10 US / $20 International)
	Direct Deposit (Click for Details)
	ePassporte (Click for Details)

4. LOGIN INFORMATION

Note: Use alphanumeric and underscore (_) characters only. Limit: 10 characters.

Password:
Verify Password:
Secret Question:
Secret Answer:

5. LEGAL INFORMATION

Date of Birth:

6. AFFILIATE SERVICE AGREEMENT

I agree to the conditions outlined in the Terms of Service Agreement

Digital Signature:
	Enter your name in the box above to digitally "sign" the form.